An Exploration of the Pillars of Leadership in Cancer Education.

Leadership plays a key role in cancer education (CE) and the success of its practices. Leaders in CE must effectively use their leadership skills to be able to communicate, collaborate, and educate their team members. There is a lack of formalized and standardized curriculums for institutions in developing leadership programs, including what themes to focus on in CE. In this article, the authors describe key pillars of leadership in CE that have presented themselves throughout their experience and within the literature. A search was conducted using the Ovid MEDLINE® database and articles were reviewed for eligibility. In this review, thirty articles were selected for their relevance to CE. With this literature search and the authors' reflections, four pillars of leadership in CE were identified: (1) leadership development, (2) collaboration, (3) diversity and equity, and (4) implementation. Within these themes, key areas of importance were discussed further, and barriers to CE leadership were identified. By reflecting upon pillars of leadership in CE, this article may be helpful for developing future leadership programs within CE. It is vital that initiatives continue to be held and barriers are addressed to increase leadership effectiveness within CE.

Developing and Evaluating Multimedia Patient Education Tools to Better Prepare Prostate-Cancer Patients for Radiotherapy Treatment (Randomized Study).

The purpose of this study is to determine the effectiveness of multimedia educational tools to improve CT planning preparation for intensity modulated radiotherapy (IMRT) for prostate cancer. Many patients are not prepared when given verbal preparation instructions to have a full bladder and empty rectum for their IMRT and require being rescanned, which results in additional costs for the patient and the hospital. A pamphlet and video outlining the proper preparation for prostate IMRT was created to decrease additional scans and the associated costs, while increasing patient satisfaction. A controlled, randomized experimental group study was conducted to examine the effectiveness of the multimedia tools (the video and the pamphlet), as compared to the pamphlet only, in preparing patients for their planning CT appointment. We found no statistical difference between the multimedia group and the pamphlet group in patients' preparedness for their appointments and the rescanning rate. However, patients in the multimedia group indicated that they felt more prepared about their treatment after watching the video and stated that they would recommend the video to other patients with prostate cancer. Furthermore, patients who had to wait longer for their planning CT appointment felt less prepared by the materials than those with a shorter wait time. We recommend reducing wait times between appointments as much as possible to increase patients' preparedness for the planning CT. We conclude that providing multimedia treatment information and minimizing wait times increases patients' feelings of preparedness leading to a more positive treatment experience and reducing costly rescans. TRIAL REGISTRATION: ClinicalTrials.gov NCT02410291.

Educating our patients collaboratively: a novel interprofessional approach.

Providing cancer patients with more information regarding their treatments allows them to feel more in control, increases self efficacy, and can decrease anxiety. The aims of the present study were to develop an interprofessional group education session and to evaluate the usefulness and acceptability of this session. In addition, informational distress levels pre- and post-education were evaluated. A prostate radiation therapy (RT) education session was developed and facilitated by an interprofessional team. Topics discussed included how RT works, side effects and management, and support services available. Prior to the education session, participants reported their informational RT distress levels using the validated Distress Thermometer (DT). Post-education session, the DT was readministered. In addition, participants completed an acceptability survey to assess format, structure, and usefulness of the education session. Participants agreed that the session contained valuable and useful information helping them understand expectations during treatment, including resource availability, side effects and management, as well as procedural expectation during treatment. All stated they would recommend the session to other patients. The interprofessional nature of the sessions was deemed useful. Suggested areas for improvement included addition of a dietitian, information on long-term side effects, statistics of radiotherapy side effects, impact of radiotherapy on sexual function, and overall quality of life. The group education session significantly improved informational distress levels (p = 0.04). Educating prostate cancer patients utilizing an interprofessional group format can decrease anxiety and stress related to their RT treatment. Future development of group education sessions for other disease site groups may be valuable.

Functional decline and resilience in older adults over the age of 70 receiving radiotherapy for breast cancer: A pilot study.

INTRODUCTION: Radiotherapy (RT) as an adjuvant, post-lumpectomy treatment has been shown to improve local control and survival in people with breast cancer. While adverse events because of cancer treatments are common, many older adults have demonstrated the ability to return to their baseline levels of physical functioning. There are limited reports on the functional decline and recovery of older patients undergoing RT. The primary objective of this study was to investigate physical function at various time points during RT in people with breast cancer over age 70 and their ability to recover post-decline. MATERIALS AND METHODS: Seventy-nine patients with breast cancer aged 70+ undergoing adjuvant RT at Sunnybrook Health Science Centre, Toronto, Ontario, Canada were enrolled for a prospective observational study. Participants completed the EORTC QLQ-C30 quality of life questionnaire before their first RT, after their final RT, and at three- and six-months post-RT to assess changes in physical function. Descriptive statistics were utilized to evaluate EORTC QLQ-C30 scores. A higher score was indicative of poorer physical function. Physical decline was a 10+ point increase in EORTC QLQ-C30 score from baseline to the last RT, and resilience was a return to <10 points from the baseline score within six months post-RT. Resistance was a post-RT change from the baseline score by fewer than 10 points. RESULTS: Nine patients (11%) experienced physical decline following their last RT, and two of them (22%) displayed resilience within six months. There were no demographic or symptom variables associated with functional decline from the baseline to post-RT, nor with resilience. Nausea, pain, and diarrhea post-RT were associated with functional decline at six months post-RT (P = 0.0185, P = 0.0449, P = 0.0007, respectively). Nausea and diarrhea at baseline were associated with resistance to decline (P = 0.0055, P = 0.019, respectively), and with decline at the six-month follow-up (P ≤0.0001, P = 0.0235, respectively). DISCUSSION: This study highlights the incidence of physical decline in patients over age 70 receiving RT for breast cancer and identifies risk factors for decline. Future research with a larger sample, longer follow-up period, and incorporating geriatric assessments pre-RT is warranted to better understand functional decline and resilience in this population.

Patient engagement in CPD in radiation oncology and radiation therapy across Canada: A national survey.

BACKGROUND: The aim of this study was to investigate patient engagement (PE) in the development and delivery of Continuing Professional Development (CPD) programs for health care providers within radiation oncology, radiation therapy and medical physics across Canada. This study looked at the current state of PE in CPD programs across Canada and how to address the benefits and barriers to PE to advance these programs. METHODS: A quantitative, exploratory survey was conducted among radiation oncologists, radiation therapists and medical physicists across Canada. The questionnaire was developed by a multi-disciplinary team and piloted among interprofessional (IP) faculty with a special interest in patient education. The survey was web-based and disseminated through the Canadian Association of Medical Radiation Technologists (CAMRT) and Canadian Radiation Oncologists (CARO) professional associations. RESULTS: A total of 97 responses were obtained, 43.3% (n = 41) were radiation oncologists 64% (n = 54) were radiation therapists and 2(2%) were medical physicists. There was representation from all provinces, except Newfoundland, with the majority 36% (n = 35) from Ontario. 57% (n = 46) of participants agreed that patients should be involved in CPD, and 11% (n = 9) disagreed. The most agreed-upon barriers are financial costs for patients and clinician bias when selecting patients. The most agreed-upon solutions were improving patient resources and creating training programs for patients. Radiation therapists agreed significantly more (p<0.05) with the potential benefits of PE in CPD, compared to radiation oncologists. DISCUSSION: PE in CPD programs is a novel and controversial topic but is still highly rated and important. We intend to advocate for patients to take an active role in our CPD programs. Further research is warranted.

Changing me to we: Developing teambuilding in radiation therapy.

BACKGROUND: There has been a causal link identified within the literature between poor team function and errors, patient outcomes, staff satisfaction and performance. Lacking is supporting evidence on teambuilding and its impact on overall team performance and team dynamics. Within radiation therapy, there is difficulty in understanding the inner workings of team dynamics due to the unique complex nature of teams and with very little evidence on the impact of team building specific to radiation therapy. The focus of this research is to form a better understanding of the effects of teambuilding before and after a teambuilding education session.The knowledge gained can help in future trainings to promote and facilitate teambuilding to develop team dynamics and lead a change in culture. METHODS: Team building sessions were booked and scheduled for 148 radiation therapists. Pre and post session evaluations were distributed to all participants and collected at the end of each team building session. Descriptive statistics were used to analyze Likert scale responses. Open-ended question responses were coded and analyzed for emerging themes using thematic analysis. RESULTS: 110 of 148 radiation therapists attended one of the scheduled team building sessions. Pre-session evaluations indicated radiation therapists have a good understanding of factors that affect teamwork (88% agree); are aware of the multi-generational impact (78% agree); have the skill set to build a respectful team (86% agree); and are comfortable dealing with conflict (67% agree). Post-session evaluations indicated that participants had gained increased knowledge on teamwork (66.3% agree; 30.7% strongly agree); are more aware of the generational impact within teams (59% agree); new strategiesdeveloped to help improve team dynamics and the ability to use the lessons learnt immediately (67% and 71% respectively agree). Open ended comments indicated an interest in additional teambuilding sessions and further education on conflict resolution. CONCLUSION: Results showed an increased awareness of the factors that impact team dynamics amongst radiation therapists and an interest in receiving further education in teambuilding. Findings will be utilized to better inform debate in future development of teambuilding educational sessions to improve overall team dynamics in radiation therapy.

Learning in 360 Degrees: A Pilot Study on the Use of Virtual Reality for Radiation Therapy Patient Education.

BACKGROUND: Patient education for external beam radiation therapy (EBRT) is traditionally delivered in verbal and/or written form, which may not provide a full picture of the complex, technical aspects of treatment. The purpose of this pilot study was to create and evaluate a prototype 360-degree virtual reality (VR) video outlining the technical aspects of EBRT to the pelvis as a supplement to traditional education methods. MATERIALS AND METHODS: A prototype VR video was filmed to simulate the delivery of one fraction of image-guided EBRT to the pelvis. Patients having a radical course of image-guided EBRT to the pelvis were approached while on active treatment to participate in focus groups evaluating the prototype VR video. Focus group discussions were recorded, transcribed, and subjected to thematic analysis. RESULTS: All patients were accrued from a single academic cancer centre in a large metropolitan area. In total, seven patients were enrolled to participate in the focus groups. Thematic analysis revealed 71% of participants felt the traditional patient education met their needs. However, 86% mentioned the education did not fully capture the treatment experience. Participants identified potential benefits of VR could include an increased understanding of the treatment process, specifically the spatial and acoustic aspects of treatment, as well as the potential to reduce anxiety in new patients. Timing was also important, with 86% of participants recommending VR video viewing before the first day of treatment. Participants provided feedback such as including two-dimensional elements in the VR video and other changes which could potentially make the viewing experience more realistic. CONCLUSIONS: Traditional teaching methods are seen as satisfactory by patients at our institution, but it is recognized that there is a gap in current education methods. An immersive VR education tool has the potential to enhance standard patient education, increasing understanding of treatment and decreasing anxiety.

Do Canadian Radiation Oncologists Consider Geriatric Assessment in the Decision-Making Process for Treatment of Patients 80 years and Older with Non-Metastatic Prostate Cancer? - National Survey.

PURPOSE: Clinical judgement may not be sufficient to detect relevant problems in older cancer patients. We investigated what Geriatric Assessment tools (GA) are used by Canadian radiation oncologists (CROs) to treat non-metastatic prostate cancer patients aged 80 years and older. METHODS: A 27-item cross-sectional survey was developed with input from a multidisciplinary team and distributed electronically to Genitourinary (GU) CROs via LimeSurvey. Survey contents included: demographics, treatment choice based on components of GA, and how GA tools are used in clinic. Descriptive statistics were used to analyze multiple-choice data, with Open-ended question being coded and analyzed for emerging themes. RESULTS: 154 GU CRO's were contacted, 44 responded (29%). Active surveillance was the choice of therapy in older low risk prostate cancer patients regardless of factors used in a GA assessment (97%). Results in intermediate and high-risk older prostate cancer patients were more heterogenous. Functional status and comorbidities were the most important factor in the decision-making-process (94%, 91%). Sixty-six percent of CROs did not use any GA tools; yet 77% felt comfortable to very comfortable treating older patients. Eighty-eight percent felt there were some to very few guidelines in helping them to treat older patients. Barriers to using GA included lack of knowledge, time, support, and resources. CONCLUSIONS: GAs are not commonly utilized by CROs. Majority of CROs felt comfortable treating older patients with prostate cancer, regardless of guidelines/evidence in this population. This may have negative implications on patient care. CROs are however open to referring patients for a formal GA.

Building a Magnetic Resonance Imaging Safety Culture from the Ground Up.

Magnetic resonance imaging (MRI) uses a strong magnetic field to generate diagnostic images. This magnetic field has the potential to cause serious and even fatal injuries to patients undergoing scans and to personnel in the area. Ensuring awareness of MRI hazards and safety procedures through a formalized education and training program is integral in creating an MRI safety culture that protects patients and staff from harm. The aim of our project was to develop an accessible and interprofessional electronic e-module learning series to instill an MRI safety culture throughout the entire hospital. This is the first such program in Canada. A simplified e-search was conducted using key search terms "mri: safety, education, safety training." Very few articles were found that fulfilled our needs in helping us build an MRI safety program. In concert with an e-search we reached out to similar institutions and, through informal discussions, we confirmed the lack of a formalized, transferable safety program within Canada. This led to the creation of an interprofessional working team at our institution composed of key stakeholders: educators, clinical and technical experts from radiation therapy, medical imaging, the research institute, medical radiation physics, nursing, and radiation oncology. This team collaborated on the development of three education modules tailored for specific audiences based on classification as Non-MR Personnel, Level 1 MR Personnel, or Level 2 MR Personnel as defined by the American College of Radiology guidelines. All modules were 10 to 20 minutes in length with interactive engagement activities throughout as well as a final summative evaluation to test for comprehension. Knowledge of the existence of the MRI unit is only one facet of creating an MRI safety culture. By increasing the awareness of the hazards of MRI to all personnel throughout the hospital, the risk of harm to patients and staff may be decreased.

Incorporating Peer Assessments within a Clinical Practicum Course: Insights from a Clinical Faculty Initiative.

INTRODUCTION: Peer assessments have been used within health professional programs to provide some degree of judgment of professional behavior and to facilitate feedback among peers. In an attempt to further support the clinical learning of our students, the clinical education team at the Odette Cancer Centre initiated a pilot to introduce peer assessments as a part of strategies for learning and engagement within laboratory sessions. The aim of our work was to retrospectively review peer assessments completed during these sessions in an attempt to identify professional behaviors, both positive and negative, and subsequently correlate the assessments with observed behaviors noted, both formally and anecdotally, within clinical faculty assessments. Further to this, our team attempted to explore student perceptions on the impact of peer assessments to their own learning. METHODS: Students in the final year of a 3-year undergraduate medical radiation sciences program were asked to assess their peers during laboratory sessions using a modified version of an assessment tool previously known to the students, the Assessment of Readiness for Clinical tool. Students (N = 14) were required to evaluate each of their peers who participated in the same session and provide supporting comments for their rating. For each student, responses from peer assessors were anonymized and collated. Comments and numerical ratings on the peer assessments were compared. The student assessments were subsequently compared with similar measures extracted from faculty assessments. Students also participated in a debriefing session to provide feedback regarding the integration of these assessments within the learning sessions and the potential impact they had on their own professional behaviors. RESULTS: The majority of students rated their peers in all criteria at a score of 2 (performed or surpassed expectations). There was some correlation between numerical ratings and comments written in the assessments. Comments on peer assessments were in concordance with observations extracted from previous assessments by clinical faculty and teachers for 71% of the students. Students expressed a favorable attitude toward the use of the peer assessments but did not find the numerical ratings useful and instead valued supporting constructive comments that cited specific examples for improvement. CONCLUSIONS: Peer assessments were found to be of some benefit to the learning of our students, particularly the anecdotal supporting comments that accompanied the ratings. However, their use must be accompanied by formalized training and guidelines to teachers and learners as well as a careful consideration of the tool chosen to ensure the most purposeful impact on behavior change.

Understanding Radiation Therapists' Perceptions and Approach to Clinical Competence Assessment of Medical Radiation Sciences Students.

BACKGROUND: Within the academic clinical setting, radiation therapists are required to assess students' performance and competence as part of their clinical practice portfolio. Anecdotal feedback from the clinical setting identified challenges in assessment that emerged as a result of variation in who, how, and the context in which the assessment was being completed. A survey was distributed to gain insight into the current state of clinical competency assessment. METHODOLOGY: Radiation therapists (n = 75) from two affiliated clinical sites within an undergraduate program were surveyed. The online survey consisted of open and closed questions. The survey was divided into three principal themes on the assessment of clinical competence: (1) who completes the assessment, (2) how clinical competence is assessed, and (3) what measures are utilized in the assessment. The survey also captured the clinical experience and formal training in education and assessment of respondents. RESULTS: All respondents were aware that clinical teaching was part of their portfolio, but only 45 (60.0%) enjoyed teaching students, 41 (55.4%) rated themselves as very comfortable assessing competence, and 69 (93.2%) were aware of documentation and support on how to evaluate. All collaborate with team members and slightly less with the clinical educators. Sixty-four (86.5%) defined successful competence as sustainability over a defined period of time, measuring both clinical knowledge and application. CONCLUSIONS: Processes surrounding the assessment of clinical competence are congruent among all clinical teachers, supporting their reliability. Enhanced collaboration with clinical educators in both support and training will increase the validity of clinical assessment. In addition, to minimize variability in clinical assessment, the focus should be placed on training the assessors and not controlling the assessment process.